Market forces are slower to affect all of rural America, with differences in the pace of change related to measures of rurality and region of the country. As the changes occur, two important questions emerge: l. How will rural health care systems react to, and possibly participate in, market changes? 2. Will the care seeking behavior of rural residents change with growth in managed care health plans in rural communities? These questions can be answered on a preliminary basis by examining impacts where changes have occurred. Each core question implies a series of more specific empirical questions. For example, the first question generates these additional questions: la. To what extent do market changes originate with rural systems? lb. Do rural providers exercise much leverage when participating in health plans operated out of urban communities? Based on those questions, the following are the specific aims of this project: l: Quantify the extent to which rural households are enrolled in managed care plans; 2: Document linkages between participation in managed care plans and utilization of health care services; 3: Develop an informed assessment of how rapidly changes are occurring in rural areas, classified by degree of remoteness from metropolitan areas; 4: Develop an informed assessment of the involvement of rural providers and community leaders in changes that are occurring; and 5: Disseminate the knowledge gained in this project directly to policy makers as well as to scholarly peers.